Friday, August 31, 2012

President Obama is expected to sign an executive order today directing the Department of Veterans Affairs (VA) to expand mental health services and suicide prevention efforts. According to a statement released today by the White House, the order will direct the VA to increase its veterans crisis line capacity by 50 percent by the end of the year and ensure that any veteran who says they are in crisis connects with a mental health professional or trained mental health worker within 24 hours. Under the order, the VA will work with the Department of Defense to develop and implement a national 12-month suicide prevention campaign focused on connecting veterans to mental health services. Among other things, the order also calls on the VA to enhance access to mental health care by building partnerships between VA and community providers.

In April the VA announced its intention to hire 1,600 new psychiatrists and mental health professionals. And in comments submitted to the Senate Committee on Veterans’ Affairs that month, APA urged the VA to bolster its efforts to recruit and retain psychiatrists. For more information on APA's comments, see Psychiatric News, here.

Janssen Pharmaceuticals, a division of Johnson & Johnson, announced yesterday that it reached a $181 million consumer fraud settlement with 36 states and the District of Columbia over its marketing of the antipsychotic Risperdal (risperidone). State and federal authorities had said that Janssen promoted the drug for uses for which it was not approved, including dementia in elderly patients, bipolar disorder in children and adolescents, depression, and anxiety disorders. Prosecutors also accused the company of minimizing or concealing risks associated with the drug.

In a statement, Janssen said the settlement is not an admission of wrongdoing or violation of any law or regulation. Rather, it agreed to the settlement to resolve claims of the attorneys general about violations of state consumer-protection laws and to “avoid unnecessary expense and a prolonged legal process.”

"We have chosen this path to achieve a prompt and full resolution of these state claims and to ensure we continue to focus on our mission of providing medicines to meet the significant unmet needs of many people who suffer from mental illness,” said company President Michael Yang.

For more information about the lawsuit see Psychiatric News here and here.

Thursday, August 30, 2012

French researchers say patients with sleep-related eating disorder (SRED) have several features in common with their non-eating-disordered people who sleepwalk. They studied 15 patients with SRED, 21 sleepwalkers, and 20 age- and sex-matched healthy volunteers, and reported their results online in Sleep Medicine. All participants underwent interviews; completed sleep, anxiety, depression, and eating behavior scales; and had a nighttime videopolysomnography. Patients with SRED were mainly women, had disease onset in adulthood, suffered nightly episodes and insomnia, and had more frequent eating problems in childhood and higher current anorexia scores than did the sleepwalkers and controls. Unlike controls, they shared several commonalities with the sleepwalkers, including high frequency of past or current sleepwalking, a similar timing of parasomnia episodes during the first half of the night, and a similarly altered level of daytime sleepiness and anxiety. They differed from the sleepwalkers in that they had a higher level of awareness during parasomnia episodes. A clinician's response to an eating-disordered patient can affect treatment outcomes. Read more about the issue in Psychiatric News, here.

The Administration for Children and Families hosted a summit in Washington, D.C., earlier this week to allow representatives from every state to engage in peer learning and hear from national experts about patterns of psychotropic medication use in foster-care children and strategies for improving oversight and monitoring. Because Minds Matter: Collaborating to Strengthen Psychotropic Medication Management for Children and Youth in Foster Care, was attended by representatives of child-welfare agencies, mental health authorities, and Medicaid offices.Because the child-welfare system is different in every state, bringing states together to talk about their challenges and solutions is an crucial first step in addressing this issue, said agency Commissioner Bryan Samuels in a conference call detailing the summit. "Having all the states here, with an opportunity to share information and approaches, is critical," he stressed.The Government Accountability Office recently examined the issue of psychotropic medication use in foster-care children after charges that they were being overused. Read about their findings in Psychiatric News, here. On a related topic, a recent article in Psychiatric Services in Advanceexamined whether youth placed with child-protective services after investigations of maltreatment by child-welfare agencies received needed mental health services.

Wednesday, August 29, 2012

Can being obese make you depressed? It all depends on other aspects of health. British researchers looked at 3,851 men and women in the English Longitudinal Study of Aging to examine the effects of obesity with and without cardiometabolic risk factors. About 28 percent of the subjects were obese, and 34 percent of those were metabolically healthy—without problems with their blood pressure, cholesterol, triglycerides, glycated hemoglobin, or C-reactive protein. Abnormalities in two or more of those factors rendered subjects “unhealthy.”

Assessment for depression at baseline and after two years showed that metabolically unhealthy obese participants had a significantly elevated risk of depressive symptoms at follow-up, but the metabolically healthy obese persons did not, wrote Mark Hamer, PhD., of the Department of Epidemiology and Public Health at University College London, and colleagues, in the September Molecular Psychiatry.

To read more about the interaction between obesity and psychiatric disorders such as autism, see Psychiatric Newshere.

For psychiatrists treating adolescents who smoke marijuana, a new study provides convincing data that may counter arguments by these youth that pot is a harmless indulgence. "Persistent and dependent use of marijuana before age 18" contributes to memory and attention difficulties and a decline in IQ scores when these youngsters become adults, reported researchers at Duke University's Center for Child and Family Policy and departments of psychiatry and psychology online in the Proceedings of the National Academy of Sciences. They followed more than 1,000 New Zealanders from birth to age 38, and began IQ testing at age 13. At age 38, several psychological tests were also administered. They found that when marijuana use was begun during adolescence and continued for years afterward, IQ scores declined by an average of 8 points between ages 13 and 38. When marijuana use was begun during adulthood, no similar cognitive sequelae were found. These data also highlight the still-developing nature of adolescents' brains.

Lead researcher Madeline Meier, Ph.D., pointed out that "While 8 IQ points may not sound like a lot...a loss of IQ from 100 to 92 represents a drop from being in the 50th percentile to being in the 29th," adding that "Somebody who loses 8 IQ points as an adolescent may be disadvantaged compared with their same-age peers for years to come."

Tuesday, August 28, 2012

Eventually, children with autism grow up to become adults with autism, yet little is known about how they can adapt to functional independence. A group of Vanderbilt University researchers working for the Agency for Healthcare Research and Quality examined the evidence for effectiveness of vocational interventions in individuals with autism spectrum disorders aged 13 to 30.

Their findings were not encouraging. Only five studies of on-the-job supports met inclusion criteria. All were small and of “poor” quality, meaning that little weight could be given to any reported improvements to quality of life, autism symptoms, or cognitive functioning, wrote lead author Julie Taylor, Ph.D., and colleagues online August 27 in Pediatrics. “Individual studies suggest that vocational programs may increase employment success for some,” they noted. “Research to quantify the degree to which these interventions are effective, under what specific circumstances, and for which individuals with [autism spectrum disorders] is critical for the growing number of adolescents and young adults with [these disorders] who are approaching the transition to adulthood.”

To read more about research in autism treatment, see Psychiatric Newshere and here.

In a study of socioeconomically disadvantaged urban mothers, both postpartum depression and intimate partner violence were reported frequently. But what was especially striking was that over half the mothers who reported being victims of intimate partner violence also reported having postpartum depression. Findings from the study, which was headed by Barry Solomon, M.D., of the Johns Hopkins Medical Institutions, were published in the August Journal of Pediatrics.

It thus looks as if intimate partner violence can sometimes contribute to, or even cause, postpartum depression, the researchers suggested. But what leads to intimate partner violence in the first place? Perhaps bullying, another study suggests. It found that boys who bully in school may be at an elevated risk, as adults, for perpetrating violence on their female partners.

Monday, August 27, 2012

Stress is known to be capable of triggering various types of illnesses, some quite serious. One way by which it does so appears to be by methylating the gene that makes the receptor for oxytocin—a hormone that performs several crucial functions in the brain and body. So reported Gunther Meinischmidt, Ph.D., of Ruhr University in Germany, and colleagues in the August 15 Translational Psychiatry. "This may enhance the understanding of how psychosocial events alter DNA methylation and could provide new insights into the etiology of mental disorders," they suggested.

In several other recent studies, researchers have reported potentially valuable insights into how stress triggers illnesses. For example, stress has been found to provoke inflammatory reactions in people's bodies, especially if they experienced early-life adversity. And the impact of stress on the heart is now known to be as deleterious as that of other cardiovascular risk factors such as smoking, high cholesterol, and lack of physical activity.

For more information about the impact of stress on people's health, see a report on the burgeoning field of psychoneuroimmunology inPsychiatric News. To read about neural mechanisms underlying stress sensitivity, see the American Journal of Psychiatry.

Eli Lilly and Company had high hopes for solanezumab, a drug developed to destroy beta-amyloid plaques that characterize the brains of people with Alzheimer's disease. But on August 24 the company announced that its clinical trials in more than 2,000 people in 16 countries showed that the drug was unable to halt the disease's progress on measures of cognition and functionality. Lilly's announcement follows by less than a month the failure of a similar drug being developed by Pfizer and Johnson and Johnson.

Lilly President and CEO John Lechleiter, Ph.D., indicated in a press release that there was some hopeful news in the pooled data from two phase 3 clinical trials, since in subjects with mild to moderate Alzheimer's taking the drug, there was evidence of "statistically significant slowing of cognitive decline. He said, "We recognize that the solanezumab studies did not meet their primary endpoints, but we are encouraged by the pooled data that appear to show a slowing of cognitive decline. We intend to discuss these data with regulatory authorities to gain their insights on potential next steps." An open-label extension study is continuing. Apparently investors interpreted this news as encouraging because Lilly's stock registered a sizable gain the day of the announcement.

Friday, August 24, 2012

Individuals infected with Toxoplasmosis gondii (T. gondii), a parasite that normally thrives in cats, are at greater risk for attempting suicide, according to an August report in the Journal of Clinical Psychiatry. A cross-sectional, observational study compared T. gondii serointensity and seropositivity in plasma from 54 adult suicide attempters who were inpatients at Lund University Hospital in Lund, Sweden, and 30 adult control subjects who were randomly selected from the municipal population register in Lund. Seropositivity and serointensity of T. gondii were positively associated with a history of nonfatal suicidal self-directed violence.

Researchers also measured the potential of patients and controls for self-directed violence using the self-rated Suicide Assessment Scale. They found that seropositivity of T. gondii was associated with higher scores on the self-rated scale for the whole sample, regardless of suicidal history.

Other research into T. gondii has found a link to development of schizophrenia. For information on that topic, see Psychiatric News here and the American Journal of Psychiatryhere.

The antipsychotic olanzapine, which has been associated with weight gain, appears to enhance reward systems in the brain that respond to food, according to a study published online in the Archives of General Psychiatry. Data from magnetic resonance imaging before and after a one-week treatment with olanzapine showed enhanced activations in the inferior frontal cortex, striatum, and anterior cingulate cortex to the anticipation of a food reward. Also seen was a decrease in activation in the lateral orbital frontal cortex, an area of the brain thought to exercise inhibitory control on feeding.

These brain changes were associated with significant increases in weight, food consumption, and disinhibited eating among 25 subjects receiving olanzapine.

To learn more about the link between olanzapine and weight gain, see Psychiatric Newshere. Read an abstract of the Archives report here.

Thursday, August 23, 2012

A study reported online August 20 in Psychiatry Research assessed the impact of a short message service (SMS, also known as text messaging) on adherence to antipsychotic medication treatment, with favorable results. In a six-month study of 254 clinically stable patients with schizophrenia, a significantly greater improvement in adherence was observed among patients receiving the messages. Greater improvement in negative, cognitive, and global clinical symptoms was observed, and attitude towards medication also significantly improved across the study in the intervention group versus the controls.

"An SMS-based intervention seems feasible and acceptable for enhancing medication adherence," concluded the researchers, who noted that further studies are needed to confirm whether this kind of intervention could be a complementary strategy to optimize treatment adherence in schizophrenia.

Read what APA President-elect Jeffrey Lieberman, M.D., says about the future of treatment for schizophrenia patients in Psychiatric Newshere. And Psychiatric Services has published a study that found text messaging effective in reminding patients about upcoming appointments at a mental health center. Read that study here.

Researchers at Mount Sinai School of Medicine say that identifying phenotypes for successful cognitive aging can help identify interventions against late-life cognitive impairment. They reported online August 15 in Neurology the results of a family history study to determine whether C-reactive protein (CRP, synthesized in the liver and used as a marker for cardiovascular disease) is associated with a reduced risk of dementia, suggesting a successful cognitive aging phenotype. They concluded that relatives of successful cognitive aging individuals with high levels of CRP are relatively likely to remain free of dementia. "High CRP in successful cognitive aging individuals may constitute a phenotype for familial—and thus possibly genetic—successful cognitive aging," they wrote. Learn more about this topic in the book Successful Cognitive and Emotional Aging, available from American Psychiatric Publishing, here.

Wednesday, August 22, 2012

Heart attacks are bad enough for the patient, and sometimes they can be pretty rough on the patient’s spouse as well, report researchers from Denmark and the U.S., in the European Heart Journal.

They looked at Danish National Health Service records of four groups of spouses (about 77 percent women) for up to a year. Those whose spouse died of a heart attack were prescribed antidepressants and benzodiazepines more often than those whose spouse died of other causes. Those whose spouse had a nonfatal heart attack (compared with those hospitalized for other reasons) had increased risk for using antidepressants and benzodiazepines. Spouses of fatal heart attack patients also had an increased risk of depression and suicide. Husbands whose wives had a fatal or nonfatal heart attack had a relatively higher increased risk of depression than female spouses.

“[O]ur study suggests that clinical attention needs to be paid to both the patient...and the spouse, who has to live through the event alongside the patient,” concluded Emil Fosbol, M.D., Ph.D., of the Duke Clinical Research Institute and Gentofte University Hospital in Denmark.

To read more about the interaction between cardiovascular disease and mental health, see Psychiatric Newshere.

One goal for scientists studying Alzheimer’s disease and other forms of dementia is spotting precursors to those disorders before symptoms appear. In a new study in the journal Neurology, researchers annually scanned the brains of 181 volunteers in the Oregon Brain Aging Study and then followed for about 20 years, when 134 subjects had developed mild cognitive impairment.

An acceleration in the percentage of white matter hyperintensity volume—a marker for cerebrovascular pathology—was observed an average of 10.6 years before mild cognitive impairment was diagnosed. That take-off point may prove significant.

“[White matter hyperintensity] acceleration may directly result in cognitive decline years later, or increase susceptibility to the detrimental effects of underlying Alzheimer pathology,” concluded Lisa Silbert, M.D., and assistant professor of neurology at Oregon Health and Science University, and colleagues. “Tracking longitudinal changes in WMH may be useful in determining those at different levels of risk for cognitive impairment and for planning strategies for introducing disease-modifying therapies prior to dementia onset.”

For more in Psychiatric News about the effects of white matter hyperintensities on dementia in the elderly, click here.

Tuesday, August 21, 2012

Despite making commitments to hire hundreds more psychiatrists and mental health professionals and to greatly increase screening of members of the military, the Army has failed to reverse the troubling trend of soldiers taking their own lives. The Pentagon announced late last week that July saw 38 soldiers complete suicides, more than double the number in June, and a record number for one month. This represented 26 active-duty and 12 reserve soldiers. Indicating how powerful an enemy suicide among members of the military is, the 38 suicides in July were more than double the number who were killed in the war in Afghanistan. Through the first seven months of this year, Army officials announced, 116 soldiers lost their lives to suicide. The Marine Corps acknowledge that it too is facing a troubling spike in suicides, with eight marines taking their own lives in July, and the year-to-date total surpassing that for all of last year. Several experts have indicated that the military might have to rethink its strategy for attacking its suicide crisis beyond hiring more clinicians and enhancing screening programs.

Psychiatric News has provided extensive coverage of the military's battle against suicide and research into the causes of the epidemic. Read some of that coverage here and here.

A Psychiatric News Alert posted on Friday, August 17, 2012, indicated that the Psychotic Disorders Work Group for DSM-5 had recommended that attenuated psychosis syndrome (APS)—a diagnostic category intended to describe individuals at very high risk for schizophrenia spectrum disorders but who have not yet had an acute psychotic break—should not be included as a diagnostic entity in DSM-5. Instead it would be listed in a third section of the manual (following the introduction and the main text listing disorders) for proposed diagnostic criteria requiring “further study."

The alert neglected to indicate that all proposed changes to the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are still under review and that all decisions by the DSM-5 Task Force and work groups must be approved by the APA Board of Trustees before becoming final.

Monday, August 20, 2012

Children who had been able to delay receiving a cookie or marshmallow treat at age 4 were found, at age 30, to have a lower body-mass index than were 4-year-olds who had not been able to delay receiving such a treat. So reported Tanya Schlam, Ph.D., of the University of Wisconsin, and colleagues August 16 in the Journal of Pediatrics. Thus it looks as if self-control regarding eating at a young age may affect weight later in life, the researchers concluded.

But it's not just a lack of self-control regarding eating that appears to contribute to obesity; losing self-control while eating seems to as well. Indeed, a number of individuals with this problem have a condition known as binge-eating disorder (BED). However, several questions still remain about the disorder. For instance, how does the mechanism of loss of self-control compare with that in alcoholism or drug abuse? And is BED binging the same as bulimia nervosa binging? For more information about this subject, see Psychiatric News.

An enzyme called HDAC2 is a promising new target for schizophrenia treatment, Javier Gonzalez-Maeso, Ph.D., of Mount Sinai School of Medicine, and colleagues reported August 5 in Nature Neuroscience. They found in studies of rodents that HDAC2 inhibitors augmented the therapeutic-like effects of atypical antipsychotic medications. They hope that one of these inhibitors might turn out to be an effective adjunctive treatment to atypical antipsychotics.

Meanwhile, another potential schizophrenia treatment may have been found—the antibiotic minocycline. Research suggests that it may be able to counter the negative symptoms of the illness. To read more about studies of minocycline in schizophrenia treatment, see the August 17Psychiatric News.

Friday, August 17, 2012

A shorter duration of untreated psychosis (DUP) appears to act as a significant predictor of better outcome in schizophrenia even in the very long term, according to a report published online in the August 2 Annals of General Psychiatry.Retrospective data obtained from clinical records were collected regarding duration of untreated psychosis and outcome variables (number of hospitalizations, number of attempted suicides, course of illness, Global Assessment of Functioning scores at last observation) for a cohort of 80 outpatients with schizophrenia (52 males, 28 females) at a university community mental health center. Mean DUP was 49 months, with no significant difference according to gender. Patients with DUP of one year or less displayed more frequent “favorable” courses of illness, more frequent cases with three or fewer hospital admissions, and better functioning. Statistical analyses confirmed that shorter DUP independently predicted a more positive outcome in terms of number of hospital admissions, course of illness, and functioning even when controlling for other possible confounding factors.

For more information on early intervention and long-term outcome, see Psychiatric Newshere.

Thursday, August 16, 2012

Attention-deficit/hyperactivity disorder (ADHD) is a well-known risk factor for cigarette smoking, but can treatment of ADHD in adolescents decrease smoking risk? Yes, say researchers at Massachusetts General Hospital and Harvard Medical School in the online August 7Journal of Pediatrics. They conducted a two-year, prospective clinical trial of extended-release methylphenidate for smoking prevention in adolescents, comparing 102 adolescent ADHD subjects—about half of whom received the treatment—with 188 adolescents who did not have ADHD. The smoking rate at the end of the study was significantly lower in ADHD subjects who were receiving stimulant treatment than it was in ADHD subjects who were not, and there was no significant different between ADHD subjects receiving stimulant treatment and non-ADHD subjects.

“Although considered preliminary until replicated in future randomized clinical trials, the findings from this single-site, open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking in adolescents with ADHD,” wrote the researchers. “If confirmed, this finding would have significant clinical and public health impacts.”

To read about a recent study that found ADHD to be a significant predictor of the development of substance use disorders in children and adolescents, see the "Journal Digest" column in Psychiatric News, here.

At its July meeting, APA's Board of Trustees voted to endorse two proposed position statements in support of access to care and civil rights for transgender individuals. In doing so, APA joins other organizations, including the AMA and American Psychological Association, in endorsing strong policy statements deploring the discrimination experienced by gender-variant and transgender individuals and calling for laws to protect their civil rights.

Access to Care for Transgender and Gender Variant Individuals concerns access to medical care and its impact on the mental health of these individuals. It explains why it is crucial to remove barriers to care and to support public and private insurance coverage for gender-transition treatment.Discrimination Against Transgender and Gender Variant Individuals concerns the pervasive discrimination transgender individuals face. It puts APA on record supporting laws that protect their civil rights and describes the mental health consequences of discrimination and lack of equal rights in areas such as health care, employment, housing, and licensing.

Wednesday, August 15, 2012

When the number of suicides among adolescents and young adults in two counties in southern Delaware spiked, health authorities called in experts from the Centers for Disease Control and Prevention (CDC). Eleven young people died by suicide between January and May 2012, compared with the previous yearly average of four. The most common means of death were hanging, followed by self-inflicted gunshot wound, consistent with national patterns, wrote Katherine Fowler, Ph.D., in the CDC report on the investigation.

Risk factors for these suicides included mental health problems (7); recent problem between decedent and parent(s) (5); legal problems (5); problems with boyfriend or girlfriend (4); substance use (4); academic problems (3); left a note, called someone, or texted about suicide (3); recent problem with peers (2); or the decedent was a sexual minority (2).

Every case had at least two of these risk factors, and more than half had at least five. The CDC recommended periodic mental health awareness training to identify youth at risk, expanded community and educational programs for young people, and a review of evidence-based suicide prevention strategies aimed at youth.

Integrating treatments for comorbid posttraumatic stress disorder (PTSD) and substance dependence resulted in reduced PTSD symptom severity than did substance dependence treatment alone, according to Australian researchers. They randomized 103 patients to receive either prolonged exposure therapy, a proven treatment for PTSD, plus usual treatment for substance dependence or usual treatment alone, wrote Katherine Mills, Ph.D., of the University of New South Wales and colleagues in the August 15 Journal of the American Medical Association.

After nine months of treatment (covering 13 90-minute sessions), symptom severity was lowered in both groups. "However, the treatment group demonstrated a significantly greater reduction in PTSD symptom severity,” wrote the authors. There was no significant difference in severity of substance dependence or changes in substance use, depression, or anxiety. “The complex trauma, substance use, and psychiatric presentations commonly found among individuals with PTSD and substance dependence should not be a deterrent to providing trauma-focused treatment,” the researchers pointed out.

To read more about treatment of patients with comorbid PTSD and substance use, see Psychiatric Newshere and the American Journal of Psychiatryhere.

Tuesday, August 14, 2012

Painful austerity measures, business failures, and years of recession have led to a startling increase in suicide rates in several European countries—so many that media outlets have dubbed these acts "economic suicides." Particularly affected by the spike in suicides, a trend that began in 2008, are Greece, Ireland, and Italy, according to an article published online in today's Washington Post. In Greece, which has the most dramatic rise in suicides, the Ministry of Health documented a 40% increase in the first half of 2011 compared with the prior year. Surveys by European health agencies also point to increased use of antidepressants over the last few years. They also report an increase in use of illicit drugs over the last few years. Further contributing to the continent's economic problems are lost productivity due to workers' depression, anxiety, and other mental health problems. The Post article notes that "public-health groups and trade unions are warning that mental health problems are reaching a crisis point and the the situation is going to get worse" as austerity measures take an even greater toll on people's lives as the economic crisis reaches its fourth year. Of course, this mental health crisis is unfolding in conjunction with severe cutbacks in publicly funded treatment services, with several community treatment facilities having shut their doors.

To read more about the link between economic conditions and suicide, see a report in Psychiatric News.

Psychiatrists who treat patients in rural areas enduring drought conditions may need to be alert to rising risks for suicide among their patients. This caution comes from a study of almost four decades of drought cycles in Australia in which researchers at the Australian National University analyzed climate data and suicide rates in rural areas from 1970 to 2007. This rising suicide risk in times of drought was greater in men than women, according to the study, which was published online August 13 in the Proceedings of the National Academy of Sciences. They found an increased relative suicide risk of 15% for males ages 30 to 49 when the drought index rose. The risk for women declined. They also found an increased risk in spring and early summer, noting that this seasonal increase has been documented in other areas as well. The researchers said that this link between drought and higher suicide risk "warrants public health focus and concern, as does the annual, predictable increase seen each spring and early summer."

They did note that "suicide is a complex phenomenon with many interacting social, environmental, and biological causal factors," and thus "the relationship between drought and suicide is best understood using a holistic framework."

Scientists have also uncovered a link between suicide and air pollutants. Read more about that research in Psychiatric News.

Monday, August 13, 2012

Old rats are generally not so good at recognizing places, and this deficiency in turn appears to be due to a loss in nerve synapses in the hippocampus. But 12 weeks of voluntary running was found to restore both recognition-memory and hippocampus nerve synapses in them. So reported Michael Valenzuela, Ph.D., of the University of Sydney in Australia, and his coworkers July 16 in Biological Psychiatry.

Exercise appears to benefit the brains of humans as well, another study has shown. It was conducted on cognitively normal subjects aged 45 to 88. In that study, individuals who exercised at or above levels recommended by the American Heart Association had lower levels of amyloid plaques—the hallmark of Alzheimer's disease—in their brains than did individuals who exercised less. The exercise benefit also extended to individuals who carried the APOE-e4 variant, which is a well-documented risk factor for Alzheimer's.

To learn more about the relationship between exercise and Alzheimer's plaques, seePsychiatric News.

A new multidisciplinary pain-research program is being launched by the National Center for Complementary and Alternative Medicine, according to a press release from the center, which is part of the National Institutes of Health (NIH). The new program will complement research being undertaken elsewhere within the NIH. Researchers participating in the program will investigate the role of the brain in pain processing and control; how factors such as emotion, attention, genetics, and the environment affect pain perception; and how chronic pain produces brain changes that can modify how the brain reacts to pain medications.

Information about what psychiatrists can do to help chronic pain patients, what role opioids can play in pain relief in the psychiatric domain, and what advances in pain medicine are coming can be found in Psychiatric Newshere and here. In addition, to read about educating psychiatrists on use of pain medications, see Academic Psychiatry here.

Friday, August 10, 2012

Assertive community treatment (ACT) is a way to get and keep people with severe mental illness engaged in care in public mental health systems. Yet too little is known about how to get such programs started and keep them operating well.

It turns out that program leaders must juggle several approaches simultaneously to make that happen, wrote Maria Monroe-DeVita, Ph.D., an acting assistant professor of psychiatry at the University of Washington School of Medicine, and colleagues, in the August Psychiatric Services. They must set clear practice standards and maintain adequate funding, train and supervise staff, integrate staff members into a good working team, and measure services delivered and collect patient outcome data. This multipronged approach can help maintain program quality even as health services researchers expand their understanding of what keeps an effective ACT program functioning.

To read more about research into what makes for a successful ACT program, see Psychiatric Newshere.

The restricted area around Japan’s Fukushima Daiichi nuclear power plant still lacks a full-time psychiatrist to provide mental health care for plant employees, according to a report in the August American Journal of Psychiatry. The plant was damaged, and thousands of people were killed by an immense earthquake and tsunami on March 11, 2011.

In May 2011, Jun Shigemura, M.D., Ph.D., of the National Defense Medical College in Saitama, Japan, was the first psychiatrist permitted to enter the affected zone. Plant workers were experiencing grief and guilt following the deaths of their coworkers and loved ones. Neighbors often blamed the workers for the disaster. “The workers showed a myriad of posttraumatic stress responses, including intrusive flashbacks, avoidance of their plant, hypervigilance toward aftershocks, fear of irradiation, and dissociative episodes,” wrote Shigemura and colleagues. The cleanup will take decades, and the long-term presence of mental health professionals is essential to help those burdened with “grief, high radiation exposure, and life-threatening experiences.

To read the report by Shigemura, click here. For more about the tsunami’s mental health aftermath, see Psychiatric Newshere.

Thursday, August 9, 2012

New information further elucidates the use of ketamine infusion to treat depression. Researchers at the Mount Sinai School of Medicine recently published in Biological Psychiatry the results of their study of the pattern and durability of the antidepressant effects of repeated ketamine infusions.

Twenty-four participants with treatment-resistant depression underwent a washout of antidepressant medication followed by a series of up to six IV infusions of ketamine administered three times weekly over a 12-day period. Those who responded were monitored for relapse for up to 83 days from the last infusion. The overall response rate at the study's end was 70.8 percent. There was a large decrease in Montgomery-Asberg Depression Rating Scale score at two hours after the first ketamine infusion, and the decrease was largely sustained for the duration of the infusion period. A response at the end of the study was strongly predicted by response at four hours, and the median time until relapse among responders was 18 days after the last ketamine infusion.

Ketamine infusion has also been used by psychiatrists specializing in palliative care to treat depression in patients with terminal conditions. Read more about it in Psychiatric News, here.

A combination of buprenorphine and naltrexone can reduce cocaine intake without producing opioid dependence--a promising step toward an effective medical treatment for cocaine addiction in humans, for which there are currently no medications approved by the FDA.

In a study funded by the National Institute on Drug Abuse and published yesterday in Science Translational Medicine, researchers at the Scripps Research Institute in La Jolla, Calif., found that combining low doses of naltrexone with buprenorphine can reduce cocaine intake without inducing opioid dependence in rats. Studies have shown that naltrexone blocks buprenorphine’s actions at one opioid-receptor type that is associated with drug reward (i.e., mu), while preserving its ability to potently interact with a second opioid receptor subtype (i.e., kappa), thought to contribute to compulsive cocaine use.

An implantable, sustained-release form of naltrexone is being investigated in the treatment of polydrug addiction. Read more about it in the Journal Digest column of Psychiatric News,here.

Wednesday, August 8, 2012

Compared with nondepressed patients, patients with depression treated in the Department of Veterans Affairs health system died younger (71.1 versus 75.9) and had more years of potential life lost (13.4 versus 10.2) as a result of both natural and unnatural causes., according to a report in the August Psychiatric Services. Depending on the cause of death, depressed patients died between 2.5 and 8.7 years earlier and had 1.5 to 6.1 years of potential life lost compared with nondepressed patients, according to data from the U.S. Department of Veterans Affairs and the National Death Index. The data were used to calculate mean age of death and years of potential life lost associated with 13 causes of death among veterans with and without depression.

Lead author Kara Ziven, Ph.D., and colleagues say these findings have important implications for clinical practice, in that they suggest that improved quality of care may be needed to reduce early mortality among VA patients with depression.The study, “Early Mortality and Years of Potential Life Lost Among Veteran Affairs Patients With Depression,” can be found here. For more information about veterans’ mental health see Psychiatric Newshereand here.

A history of intrauterine antipsychotic exposure was associated with significantly lower scores on a standard test of neuromotor performance among 6-month-old infants, according to an August 6 online report in Archives of General Psychiatry. Infants prenatally exposed to antipsychotics showed significantly lower scores on the Infant Neurological International Battery (INFANIB)—a test of neuromotor skills—than those with antidepressant or no psychotropic exposure. However, the INFANIB scores were also significantly associated with maternal psychiatric history, suggesting the need for further research on the role of antipsychotics in pregnancy.The Archives report is based on a prospective controlled study conducted from December 1999 through June 2008 at the Infant Development Laboratory of the Emory Psychological Center. Researchers examined 309 maternal-infant dyads at six months postpartum; mothers had taken either an antipsychotic or an antidepressant during pregnancy or had no exposure to psychotropic medications.For more information about the use of antipsychotic medications during pregnancy, see Psychiatric Newshere. Also see the American Journal of Psychiatryfor a study on use of lithium during pregnancy and postpartum in women with bipolar illness.

Tuesday, August 7, 2012

Proponents of repetitive transcranial magnetic stimulation (rTMS) see a bright future for the procedure in treating depression. Some rTMS entrepreneurs even envision a chain of treatment facilities in shopping centers and elsewhere, much like those now-ubiquitous laser eye centers, according to an article on rTMS in today's Washington Post.The problem is that, unsure of its long-term efficacy and leery of covering an expensive new procedure, very few insurers will cover the cost of the treatment, though there are indications that a change is in the wind, as the New England region's Medicare program began covering rTMS in January. Approved by the Food and Drug Administration in 2008 to treat major depression in adults who did not respond to antidepressant therapy, the procedure has shown few side effects and, unlike ECT, does not require anesthesia. About one-third of the approximatley 8,000 rTMS patients to date see positive results from the procedure, the Post noted, with costs for the series of treatments ranging from about $6,000 to $12,000. Questions remain, however, about how long the treatment effects last and if there will be any long-term side effects.

When faced with having to decide whether to throw something away or keep it, the brains of people with hoarding disorder show different reactions than do the brains of those with obsessive-compulsive disorder (OCD) and of healthy control subjects. The abnormal activity occurs in the anterior singulate cortex and insula. "Specifically, when deciding about items that did not belong to them, patients with [hoarding disorder] showed relatively lower activity in these brain regions. However, when deciding about items that belonged to them, these regions showed excessive functional magnetic resonance imaging signals compared with the other two groups." The study was conducted by David Tolin, Ph.D., of the Institute of Living in Hartford, Conn., and Yale University School of Medicine and colleagues.

Hoarding disorder is being proposed as a new diagnosis distinct from OCD in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It has often been considered a subtype of OCD, but recent research has found that many hoarders do not exhibit symptoms that meet current diagnostic criteria required for an OCD diagnosis. To read about hoarding disorder research and discussions of whether it should be a distinct disorder in DSM-5, see Psychiatric News.

Monday, August 6, 2012

When the hormone oxytocin is given to the fathers of 5-month-old infants, it increases the fathers' social interactions with their infants, and the infants respond accordingly. So reported Omri Weisman, Ph.D., of Bar-Ilan University in Israel, and his colleagues on July 16 in Biological Psychiatry.

Other studies of oxytocin have also shown that when it is given as a medication, it can enhance social interactions between people. Furthermore, oxytocin administration is being tested to see whether it might help individuals with deficits in social functioning—for example, those with social anxiety disorder or autism spectrum disorders. Read about that research in Psychiatric News.

How oxytocin that is normally present in the brain and body works is also being explored. Scientists found recently, for example, that women who have a particular variant of the oxytocin gene are more anxious and respond more to stress than do women with another variant of the gene. That research can also be read in Psychiatric News.

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